Tag Archives: coronary angiography

Introduction Takotsubo syndrome (TTS) and spontaneous coronary artery disease (SCAD) may present with similar clinical characteristics, such as chest pain, elevated cardiac biomarkers and comparable wall motion patterns on echocardiography. It is estimated that 7% of patients presenting with a provisional diagnosis of TTS have angiographic evidence of SCAD. Angiography and cardiac magnetic resonance imaging (MRI) are essential tools for the diagnosis of co-existent TTS and SCAD. Case report A 59-year-old woman, with a previous history of anxiety and smoking, was admitted for sudden retrosternal pain after an argument with a relative. Physical

Introduction Introduced by Dr Lucien Campeau in 1989, transradial vascular access (TRA) is now the standard approach for diagnostic coronary angiography due to a reduced incidence of complications compared with femoral access, increased patient satisfaction, a quicker recovery time and a reduction in mortality in those with ST-elevation myocardial infarction (STEMI).1 Radial access is associated with a 77% reduction in major vascular complications compared with transfemoral access, and is, therefore, recommended as the default access for patients presenting with acute coronary syndromes in current European Society of Cardiology (ESC) guidelin

Introduction Giving heparin with radial artery access cardiac catheterisation is standard practice to prevent radial artery occlusion (RAO).1,2 However, this is complicated by access-site bleeding in nearly one quarter of cases,2,3 and more significant forearm haematoma approaching a 10% incidence with the 6Fr catheter system.4 The ‘newer’ distal radial artery (dRA) approach, where the radial artery is punctured in the anatomical ‘snuff box’, i.e. beyond the radial artery bifurcation into the palmar arch branches, has significantly less RAO.5 Hence, we have defaulted to the dRA approach in our allcomers’ cardiac catheterisation prac

Introduction Computed tomography (CT) coronary angiography (CTCA) is the National Institute for Health and Care Excellence (NICE) recommended1 first-line investigation for patients with typical or atypical chest pain who have no previous diagnosis of coronary artery disease (CAD). The clinical utility of this imaging modality is underpinned by its excellent sensitivity (99%) and negative-predictive value (97%) for CAD.2 However, CTCA lacks specificity for clinically significant CAD.3,4 CTCA overestimates occlusive plaque disease, with less than half of severe stenoses causing ischaemia.3 This has led to concerns that a CTCA approach alone, wh

Future role? This study by Yasin et al. suggests that there could be a role for experienced nurse operators in the future. However, since the inception of nurse-led angiography in the late 1980s, there have been considerable advancements in the technology and infrastructure within interventional cardiology centres. The number of centres now performing coronary angiography and percutaneous coronary interventions (PCI) has considerably increased, forming part of a larger group of strategic cardiac networks.4 Diagnostic coronary angiography, and the management of non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarct

Figure 1. Angiographic still (RAO cranial) demonstrating left anterior descending (LAD) draining to the right ventricle (RV) Five months later, the patient reported continuing on/off episodes of minimal exertional shortness of breath and intermittent atypical chest pain. Echocardiogram and coronary angiography were arranged. Echocardiograph showed a preserved left ventricular systolic function. Ejection fraction: 55% with mild anterior septal hypokinetic wall. Coronary angiography: left main stem (LMS) and dominant left circumflex (LCx) were normal. The left anterior descending (LAD) artery was normal, however, the distal part appeared to dra

Introduction Figure 1. Diagnostic coronary angiogram via right femoral artery illustrating the presence of a large tortuous right coronary artery (RCA) with collaterals filling the left coronary arterial system (LCA) and retrograde flow of contrast within the main pulmonary artery (PA) Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital condition that often proves fatal in infants. However, we present a case of a young patient presenting with angina-like chest pains since childhood, who subsequently underwent successful surgical correction resulting in alleviation of symptoms. Case report A 25-year-old

Figure 1. Anteroposterior (AP) view, showing the hypoplastic left anterior descending (LAD) arising from right coronary cusp Introduction Coronary anomalies are congenital abnormalities in the coronary anatomy of the heart. They are found in approximately 1% of the population undergoing coronary angiography,1 and are often associated with other structural heart disease. Coronary artery anomalies are a cause of sudden death in the young athlete in the absence of additional heart abnormalities. The aim of this report is to revise this important but often neglected topic, its clinical implications, and to discuss a rare case that was recently en

Introduction In the modern era, patient safety has become one of the most important issues facing doctors and institutions. Cardiology is a craft speciality. Procedures must be learnt by trainees, but there is a risk, in so doing, of harming patients. The purpose of this study was to ask whether it is possible, albeit within a single institution, to provide training in coronary angiography at a district general hospital (DGH) without causing harm, by comparing the complication rate of trainees with consultants in a large case series. Methods Between August 2010 and December 2013, procedural complications resulting from cardiac catheterisation

Introduction There is no universal definition for stable angina, as there is for acute coronary syndrome.1 The diagnosis may be based on clinical history alone or on clinical history supplemented by functional testing, or angiography, or both. Angina pectoris is most often due to obstruction to flow in the epicardial coronary arteries, and the ‘gold-standard’ investigation, to date, to detect this, has been invasive coronary angiography.2 A small proportion of patients may have angina with unobstructed coronary arteries secondary to either microvascular coronary disease or coronary spasm.3 Functional ischaemia is not routinely tested for